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 OMB Collection No 2120 0724 2017

OMB Collection No 2120 0724 2017

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Information Collection Clearance Officer AES-200. PRIVACY ACT STATEMENT This statement is provided pursuant to the Privacy Act of 1974 5 USC 552a The authority for collecting this information is contained in 49 U.S.C. Block 11a. Country of Medical Certificate Select either United States or Other. If Other is selected please enter the name of the country in the space provided. Block 11b. Block 10. Is the foreign license under an order of revocation or suspension Check Yes or No. Block 11. What...
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